* Painkiller overdoses killed 15,000 people in America in
* Prescription-drug abuse kills more than cocaine and heroin
* Average of three people a day die in Kentucky
By Mary Wisniewski
CHICAGO, May 30 When a new patient comes into
Dr. Shawn Jones' office in Paducah, Kentucky complaining of
pain and asks for a specific drug without talking about other
symptoms, Jones gets suspicious.
"The first thing they say is they're in horrible pain and
they need pain medicine," said Jones. "The other thing that
gives it away is they want to tell you what works - they tell
you they want Percocet. They don't talk about their symptoms -
they don't say, 'Oh, two weeks ago I hurt my back.'"
These are the types of red flags that can send Kentucky
doctors to check a state database to see if a patient is "doctor
shopping" for addictive painkillers.
Prescription drug abuse kills more people a year in the
United States than cocaine and heroin combined, according to the
Centers for Disease Control. A CDC report last year said 15,000
people died as a result of overdoses of prescription painkillers
in 2008 - more than three times the number in 1999.
Kentucky is a hot spot. Nearly 1,000 people in the state
died from prescription drug overdoses in 2010, or about three a
day, ranking it among the top states for such deaths.
In America as a whole, about 12 million people aged 12 and
older reported non-medical use of prescription painkillers in
Abusers and dealers typically get drugs by finding doctors
willing to prescribe them, forging prescriptions, theft from
pharmacies or individuals, or buying from "pill mills" --
storefront clinics that sell painkillers for cash up front.
State databases such as one used in Kentucky are designed to
address the first problem -- to alert prescribers that someone
may be abusing drugs or diverting them for illegal sale.
Forty-three states now have databases to keep track of who
is getting prescriptions for powerful pain relievers such as
oxycodone, Vicodin and Opana.
Pharmacists enter prescriptions for controlled substances
into the database, so prescribers can see if patients are
getting pills at multiple locations.
Another five states have passed laws to create databases,
but have not yet implemented them. Missouri and New Hampshire do
not yet have such laws, though they have been introduced in the
legislatures, according to Sherry Green, CEO of the National
Alliance for Model State Drug Laws. There is no national
database, though more states are sharing information.
For some doctors, running a "PMP" -- shorthand for a
Prescription Monitoring Program report -- has become as normal a
part of seeing new patients as measuring blood pressure.
But the programs have not been without controversy, with a
major issue being whether doctors should be required to check
the database when prescribing addictive medicine, or whether
this should be left to their discretion, said Green.
Some doctors have expressed fears that PMPs could breach
patient confidentiality and interfere with needed treatment of
pain or could be used against doctors who need to prescribe a
lot of pain medicine.
Doctors also object to proposals they see as putting law
enforcement above health care. Citing privacy concerns, the
Kentucky Medical Association fought successfully against a
provision that would have moved the state's database to the
Attorney General's office, the state's top legal officer.
In Kentucky, fewer than a third of prescribers have an
account with the state's PMP program. However, a new state law,
which will take effect on July 12, makes it mandatory to run a
PMP for a new patient getting certain kinds of medicine. Nine
other states have passed laws that require doctors to access the
PMP database under certain circumstances.
"Before we can ever address the prescription-drug problem
... one of the things we have to do is to make sure we have full
use of the tools we have," said Van Ingram, executive director
of the Kentucky Office of Drug Control Policy.
Enforcement is up to state medical boards and state systems
vary. But most allow doctors and pharmacists to access
information from neighboring states - something that helps
address the problem of abusers driving over state lines to find
a willing doctor.
Improved technology, with a push by the National Association
of the Boards of Pharmacy, is helping more states share data.
Doctors and pharmacists who suspect a patient is diverting
can alert police. "If you recognize someone is a doctor shopper,
you report it to the state police diversion agent," said Sarah
Melton, a clinical pharmacist in Virginia. "I have him on speed
Another issue for doctors is time, so states are trying to
increase database speed so that doctors can get information
while a patient is still in the office. About a dozen states
allow doctors to delegate people to look up information.
Many states allow law enforcement to access the system - in
limited circumstances, and a case must already be under
investigation for officials to run a PMP report.
"You can't just pick someone out of the phone book and run
them," said John Burke, president of the National Association of
Drug Diversion Investigators and commander of the Drug Task
Force in Ohio's Warren County.
Doctors need to strike a balance between treating people who
genuinely need pain medication, and making sure it doesn't go to
people who don't, said Samuel Hughes Melton, the husband of
Sarah Melton and the president of a Virginia health clinic.
He used a PMP report to discover that a long-time patient
had picked up an opiate from another doctor, and had also
obtained a prescription for benzodiazepine. The two can be
deadly if combined.
"I was able to confront him in the exam room," Melton said.
"I was able to use that information and nudge him into treatment
for substance abuse."
There is some evidence that the databases are leading to the
prescribing of fewer addictive medicines.
According to a study by the emergency department of the
University of Toledo's College of Medicine, doctors or
pharmacists who reviewed state prescription drug data changed
how they managed cases 41 percent of the time.
The study found that 61 percent prescribed either no opioid
medications, or less than originally planned, while 39 percent
decided to provide more.
"I know a number of emergency-room physicians tell us how
much they appreciate the system to discriminate between real
patients with real injuries and those who just want drugs," said
Danna Droz, the administrator of Ohio's PMP.
Jones, the president of the Kentucky Medical Association,
said doctors and pharmacists needed more education on abuse and
diversion, as abusers become more sophisticated at fooling
He said he once got a call from a pharmacist questioning a
prescription for 90 Percocet pills - when the pharmacist knew
Jones rarely prescribed more than 20 pills at a time.
The prescription was forged. Jones reported it to police and
the phony patient was arrested.
(Reporting By Mary Wisniewski; Editing by Greg McCune and David